Ng Pamela, Incekol Diana, Lee Roy, Paisley Emma, Dara Celina, Brandle Ian, Kaufman Marina, Chen Christine, Trudel Suzanne, Tiedemann Rodger, Reece Donna, Kukreti Vishal
Dept. of Pharmacy, Princess Margaret Cancer Centre, UHN Toronto, ON
Dept. of Nursing, Princess Margaret Cancer Centre, UHN, Toronto, ON.
J Oncol Pharm Pract. 2015 Aug;21(4):285-92. doi: 10.1177/1078155214533367. Epub 2014 Apr 29.
Subcutaneous injection is now commonly used as a standard for bortezomib administration. The bortezomib (Velcade(®)) product monograph recommends that intravenous injections be prepared at a concentration of 1 mg/mL, while subcutaneous injections may be prepared at a concentration of 2.5 mg/mL. Many institutions and subcutaneous administration guidelines use 2 mL as the maximum volume for subcutaneous injection. Using 2 mL as the maximum volume for injection would mean that many patients receiving bortezomib will receive two injections during each visit with common dosing parameters. In this prospective study evaluating a change to subcutaneous administration, bortezomib 1 mg/mL was administered subcutaneously at a higher maximum of 3 mL per injection site. For 57 individual patients, 339 doses were administered. Skin reactions were noted in 42% with all reactions being Grade 1 or 2. Patients tolerated subcutaneous injections well and only four patients were switched back to intravenous route. This is the first time that subcutaneous bortezomib of a volume up to a maximum of 3 mL (bortezomib 3 mg) per injection site has been reported. This higher single dose is well tolerated with limited skin reactions, no significant hypotension and facilitates ease of administration with only 5 patients needing two injections per visit. If the maximum volume for injection was kept at 2 mL, a total of 46 patients would have received two injections per visit.
皮下注射现已普遍用作硼替佐米给药的标准方式。硼替佐米(万珂(®))产品说明书建议静脉注射的配制浓度为1毫克/毫升,而皮下注射的配制浓度可为2.5毫克/毫升。许多机构和皮下给药指南将2毫升作为皮下注射的最大体积。以2毫升作为注射的最大体积意味着许多接受硼替佐米治疗的患者在每次就诊时按照常见给药参数将接受两次注射。在这项评估皮下给药方式改变的前瞻性研究中,皮下注射1毫克/毫升的硼替佐米,每个注射部位的最大剂量提高至3毫升。对57例个体患者共给药339剂。观察到42%的患者出现皮肤反应,所有反应均为1级或2级。患者对皮下注射耐受性良好,只有4例患者换回静脉给药途径。这是首次报道每个注射部位皮下注射最大体积达3毫升(3毫克硼替佐米)的情况。这种较高的单次剂量耐受性良好,皮肤反应有限,无明显低血压,且便于给药,每次就诊只有5例患者需要注射两次。如果注射的最大体积保持在2毫升,总共将有46例患者每次就诊接受两次注射。